Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

The total artificial heart in refractory cardiogenic shock: saving the patient versus saving the heart

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 64–65 (2008)Cite this article

The past two decades have seen dramatic advances in the rapid diagnosis and treatment of acute myocardial infarction (AMI). In the setting of acute coronary occlusion, 'time is muscle', and rapid reperfusion via percutaneous coronary intervention or thrombolytic therapy has become the primary approach to limit the extent of myocardial damage. Despite these advances, cardiogenic shock complicating AMI remains an important cause of morbidity and mortality. Cardiogenic shock continues to occur in up to 10% of patients with AMI and is associated with an in-hospital mortality of 50–80%.1 In this Viewpoint we discuss the use of the total artificial heart (TAH-t) in patients with AMI cardiogenic shock, with the vision that this device could provide a lifeline for patients who might otherwise not survive.

Traditionally, cardiogenic shock complicating AMI is thought of as a single entity. When discussing the role of new aggressive mechanical therapies, however, it is useful to subdivide cardiogenic shock into acute transient shock and protracted refractory shock, on the basis of clinical features and the 'slope' of the patient's decline or recovery. Individuals with transient shock have rapid decline of hemodynamic function, which may be transitory as a result of myocardial stunning, but are responsive to revascularization, inotropic agents, and pressor support. In contrast, patients with protracted shock are refractory to intensive medical therapy, typically do not recover, and are faced with near certain death. These individuals are more likely than patients with acute transient shock to have a large anterior wall infarction, pre-existing ventricular dysfunction, and a stuttering progression of infarction. The clinical recognition that a patient is developing protracted refractory shock is vital as it requires more aggressive therapy to ensure survival.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Hochman JS (2003) Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation 107: 2998–3002

    Article  Google Scholar 

  2. Mehta VK et al. (2000) Mechanical ventricular support as bridge to transplant: risk factor and selection. ASAIO J 46: 180

    Article  Google Scholar 

  3. Copeland JG et al. (2001) Comparison of the CardioWest total artificial heart, the Novacor left ventricular assist system and the Thoratec ventricular assist system in bridge to transplantation. Ann Thorac Surg 71 (Suppl): S92–S97

    Article  Google Scholar 

  4. Mancini D and Burkhoff D (2005) Mechanical device-based methods of managing and treating heart failure. Circulation 112: 438–448

    Article  Google Scholar 

  5. Ohman EM and Hochman JS (2001) Aortic counterpulsation in acute myocardial infarction: physiologically important but does the patient benefit? Am Heart J 141: 889–892

    Article  CAS  Google Scholar 

  6. Leshnower BG et al. (2006) Safety and efficacy of left ventricular assist device support in postmyocardial infarction cardiogenic shock. Ann Thorac Surg 81: 1365–1370

    Article  Google Scholar 

  7. Mehta SM et al. (1995) Combined Registry for the Clinical Use of Mechanical Ventricular Assist Pumps and the Total Artificial Heart in conjunction with heart transplantation: sixth official report—1994. J Heart Lung Transplant 14: 585–593

    CAS  PubMed  Google Scholar 

  8. Copeland JG et al. (2004) Cardiac replacement with a total artificial heart as a bridge to transplantation. New Engl J Med 351: 859–867

    Article  CAS  Google Scholar 

  9. Slepian MJ et al. (2007) Use of the total artificial heart for salvage of patients with refractory cardiogenic shock complicating acute myocardial infarction. J Heart Lung Transplant 26 (Suppl):S90

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MJ Slepian is Professor of Medicine (Cardiology) and Director of Interventional Cardiology and JG Copeland is the Michael Drummond Distinguished Professor of Cardiovascular and Thoracic Surgery at the University of Arizona Sarver Heart Center, Tucson, AZ, USA.,

    Marvin J Slepian & Jack G Copeland

Authors
  1. Marvin J Slepian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jack G Copeland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marvin J Slepian.

Ethics declarations

Competing interests

MJ Slepian and JG Copeland have acted as Consultants for and are Directors/Stockholders of Syncardia Systems, Inc.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slepian, M., Copeland, J. The total artificial heart in refractory cardiogenic shock: saving the patient versus saving the heart. Nat Rev Cardiol 5, 64–65 (2008). https://doi.org/10.1038/ncpcardio1085

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1085

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing